Digital Health Program May Help Patients With Diabetes, Prediabetes

Virginia Signal, PhD

A mobile- and web-based health intervention program for diabetes and prediabetes management may be a solution for helping patients with the disease.

The program, which was generally well-received by patients, saw high engagement that gradually decreased. Adherence to the program, individualized programs, and technical barriers needed to be addressed to maximize potential health benefits.

Virginia Signal, PhD, and a team of investigators used the BetaMe/Melon digital health intervention for people with type 2 diabetes or prediabetes. The program lasted 12 months and had an initial 16-week active support phase of 4 interventions, health coaching, goal setting and tracking, online peer support in a secure forum, and provision of evidence-based resources. The final 36 weeks used online peer support and goal tracking only.

The team conducted a randomized controlled trial and compared the outcomes of patients aged 18-75 years old with HbA1c of 41-70 mmol/mol enrolled in the program or receiving usual primary health care. The investigators recruited 429 participants, with 215 randomly placed to the intervention arm and 214 allocated to the control arm.

Data were collected from the mobile/web platform, an online questionnaire completed during the final study assessment, and telephone interviews conducted with a subset of participants at the end of the study period. For the questionnaire, participants were asked about the usefulness of the full 12-month program and whether they would recommend it to others. There were 18 phone interviews conducted by a researcher to get in-depth perceptions about the most and least useful components of the program, barriers to incorporating the program into daily life and suggested changes to the program.

Primary study outcomes included mean changes in HbA1c and weight from baseline to 12 months.

Of the intervention participants, 92% received an initial health coaching session, while 74% (95% CI, 68-80.1) were actively engaged at some point during the 16-week active support phase. The team noted women were more likely to actively engage at any time (82.4%) than men (66.4%).

Overall, there was a steady decline in the usage of the digital health program over the 16-week support phase, from 50% of participants engaging at week 0 down to 22.3% at week 15. Participants in the youngest age group (35-54 years old) had higher engagement than other age groups. Still, by around week 6, the engagement rates converged with those of other age groups.

Diary entries were the most common and frequent form of engagement by all participants.

Nearly 84% of intervention arm participants completed the online questionnaire. Participants rated the education resources and health coaches as more useful components of the program, with 63.7% and 59.2% either agreeing or strongly agreeing with such statements. Goal tracking and online peer support were viewed as less useful, while the overall program was seen as easy to use. More than 60% of participants noted they would recommend the program to friends and family.

Participants who were interviewed by phone mostly indicated they had a positive experience and were able to increase their knowledge of diabetes or prediabetes, resulting in behavior change. Conversely, some participants had difficulties connecting or staying connected to their health coach. Similar to the results of the online questionnaire, participants found the online peer support and goal tracking to be the least useful components.

While the program was generally well-received by patients, it will be important to learn how to improve steady engagement and get the most out of such a digital health intervention.

The study, “A Mobile- and Web-Based Health Intervention Program for Diabetes and Prediabetes Self-Management (BetaMe/Melon): Process Evaluation Following a Randomized Controlled Trial,” was published online in the Journal of Medical Internet Research.